1. FFT: Relational Assessment Review BC Planning
Kellie Armey MSW., LISW-S
FFT LLC National/International Trainer/Consultant Supervisor

2. Relational Assessment
1. Behavior Pattern: What are the typical behavioral interactions of the family/dyads. It is WHAT IT IS.
2. Relational Functions: Core motivators of family members
A. Relatedness: Contact/Midpointing/Autonomy
B. Hierarchy: Power within relationships

3. Behavior Pattern: It is what it is.

4. Relational “Functions”
“When X relates to Y, the typical relational pattern (behavioral sequence within the relationship ) is characterized by degrees of:
Relatedness….contact vs. distance (psychological intensity)
Hierarchy….relational control/influence
Goal..understand and use…
Attempting to change these basic motivational
components of human behavior in just a few sessions
is clinically impossible and ethically inappropriate

5. Dimension 1: Relatedness
contact
midpoint
autonomy

6. Contact: closeness, dependency, enmeshment, (Fear of abandonment?)
Interpersonal Relatedness Functions: A “blend” over time of interpersonal dynamics in each important relationship
high 1 2
Autonomy:
distance
independence
separating,
(Fear of Enmeshment?)
3 Mid-
pointing 4 5
low
low
Contact: closeness, dependency, enmeshment, (Fear of abandonment?)
high

7. Behaviors
Contact
distance
activities
working
friends
hugging
hitting

8. Dimension 2: Hierarchy
Hierarchy
1-UP
Symmetrical
1-Down

9. Hierarchy: What and the Why
power
position
resources

10. Relational Hierarchy: pattern of degree of relational control and influence over time
When X relates to Y, the relational pattern (behavioral sequences in the relationship ) of X’s behavior is characterized by: 1 5 3 2 4
Symmetrical
One-up
One-down
Symmetrical:
Exchange = Behaviors
Degree of control or
influence
Degree of control or
influence

11. How relational assessments help
Helps suggestions / recommendations be obtainable
May help you to “match to”
May help how you link to services or what services you might refer to
Help understand how family might react to referrals, share or report info, follow-though with interventions
Helps open up options that are workable
May help motivate and follow through

12. Transitioning from Motivation to Behavior Change
Have you met your goals of motivation?
Have you been able to change meaning with the family regarding the problem?
Have you assessed relational functions and hierarchy?
If you can answer yes to the above, then you are ready to move into Behavior Change
Copyright FFT LLC 2012

13. Transitioning from Motivation to Behavior Change
Have you met your goals of motivation?
Have you been able to change meaning with the family regarding the problem?
Have you assessed relational functions and hierarchy?
If you can answer yes to the above, then you are ready to move into Behavior Change
Copyright FFT LLC 2012

14. Use of Risk and Protective Factors
Risk Factors
Identifying factors which stem from the individual, family and environment
Responding to risk factors via FFT techniques
Therapist response to referred risk factors of youth within family context.
Protective Factors
Identifying factors which stem from the individual, family and environment
Incorporating factors within therapist responses
Development and future use of factors when planning for behavior change phase
Copyright FFT LLC 2012

15. Risk and Protective Factors
Risk Factors
Protective Factors
Cellular to Social Context
Strong Neighborhood Attachment
Anti-drug Use Policies
Academic Competence
Parental Involvement
Poverty
Drug Availability
Parent
Substance Abuse
Lack of Parental Supervision
Domains
Early Aggressive Behavior
Individual
Self Control
Family
Peer
School
Community
Copyright FFT LLC 2012
Adapted from NIH Publication No (A) Second Edition October 2003

16. Developing a Behavior Change Plan
Review the Family Behavioral Pattern
Review Risk and Protective Factors
Identify the skill deficits and skill strengths of family
Identify the specific skills you want to address with each family member
Determine how to best teach that skill based on relational functions, hierarchy, family learning style, family interests
Copyright FFT LLC 2012

17. Behavior Change Targets
Behavior Change is about eliminating problem behaviors of all family members through…
Family skill development (parenting, communication, supervision and monitoring)
Specific behavioral strategies that target triggers for substance use (CBT strategies for mood and anxiety triggers, relationship skill strategies for relational triggers, etc
Specific strategies that target other problem behaviors (substance use, truancy, AWOL, etc)
Considering developmental stages (and cognitive abilities) of family members
Copyright FFT LLC 2012

18. Rationale
Prior to introducing a change topic such as communication or problem-solving skills training, the therapist provides a rationale for focusing on the topic
Why the task is important?
How it is relevant to this family?
Grounding in referral problem or content, but not necessarily the reframes or themes established in Motivation
In fact, it is often completely distinct from or unrelated to the content of earlier phases
Copyright FFT LLC 2012

19. Behavior change phase: attitudes, processes, goals, evidence, examples of matching

20. Behavior Change Attitude
Equally important as therapist “Attitude” is in Engagement and Motivation Phases is therapist “Attitude” about the change process of Behavior Change
The most essential therapist attitude is about respect of family structure (via relational functions) as the organizing element of all activities in Behavior Change.

21. Behavior Change Process
Behavior Change is about eliminating problem behaviors of all family members through core skill development and problem behavior specific strategies both dictated by Relational Functions
Nothing in Behavior Change can occur without first organizing it within the Relational Function structures of the family relationships…and without also considering developmental stages (and cognitive abilities) of family members

22. Behavior Change Goals Problem behavior elimination….
Of all family members and of the REFERRED behavior
Via core skill development
Communication, problem solving, parenting, conflict management
Via problem behavior specific strategies
Cognitive-Behavioral strategies for depression
Contingency Management or ABC strategies for substance abuse
PCIT or Incredible Years strategies for parenting deficiencies
Behavioral Couples Therapy Caring Days for relationship building
Etc, etc, etc…it is about identifying appropriate strategies for the unique problem behaviors
All organized within Relational Functions

23. Structure of Behavior Change Sessions
Set-up (review of behavioral patterns, links to Motivational themes, etc)
Rationale
Explanation (how much, what is relevant) of skills to be developed in this session
Why we are doing it (potentially)
Brief and clear description of task
Who is doing what
Practice, practice, practice
Role playing
Coaching
Directing

24. Structure of Behavior Change Sessions
In absence of skill development via family member role plays and practice…Behavior Change is not taking place
If sessions are predominantly spent using Motivation interventions (reframing, themes) and no practice…what is going on?
Moved too quickly to Behavior Change?
Overestimated levels of Motivation?
Relational Functions assessment was correct but poorly matched?
Matching to Relational Functions was accurate but the assessment of those functions was incorrect?
Therapist was not anchored in session by Behavior Change goals and processes?

25. Therapist Plans for Behavior Change Sessions
Based on full phase plan for Behavior Change, what portion of the plan will be the focus of today’s session?
Having clear and identified goals (what specific skills, what problem behavior specific strategies, how to carry out within relational functions) helps anchor the session

26. Behavior Change Session: Preparing for the Unexpected
In particular, when your plan includes some situation- specific practice areas for role playing (fight between family members that happened last night, argument about how much time being spent with boyfriend, etc) without clear anchoring to session goals (skill and strategy development) and the family is in an unexpected “crisis” when you enter their home, then your plan helps you pivot to make use of the current circumstances you are facing to role play and ultimately stay focused on your session goals (skill and strategy development within Relational Functions)

27. Behavior Change Session: Responding to Unexpected Events…Staying Grounded
When you enter into the session and run into “unexpected events”, how do you conceptualize and address them?
How “different” are these events from day- to-day family interactions?
New “song” but same family “dance”?
Should your Behavior Change session plan (skills, strategies, relational functions) be tossed aside or instead is it precisely what is needed to address immediate family needs?

28. Behavior Change Session: Responding to Unexpected Events…Staying Grounded
Meaning, does this new circumstance (Dad got arrested last night, kid didn’t come home last night, etc) represent an entirely different family behavioral pattern or is it “more of the same” (routine family behavioral pattern)…therefore requiring you to slightly alter but ultimately stick to your original session plan of building of specific skills and strategies?

29. Behavior Change Sessions: Using Motivation Interventions as Route to Getting Back on Track with BC Session Goals
Family negativity, blame, discouragement will likely raise it’s ugly head in Behavior Change
What to do?
Return fully to Motivation Phase?
Use Motivation Interventions to immediately reduce negativity and blame so as to resume Behavior Change Phase goals?
What’s important is to keep your eye on the ball of your session goals, how this immediate negativity and blame is a part of the routine family patterns, and resume skill development

30. How do you know Behavior Change is working?
Evidence of Progress Behavior Change
Referral Behaviors of youth(s)
Referral Behaviors of parent(s)
Other Changeable Risk Factors
Enhancement of Protective Factors
Skill development in session and outside session
Family adapting Behavior Change plan even further to help improve how they interact and meet functions

31. Evidence of Progress in Behavior Change
Targeting Elimination of Referral Behaviors via:
Improved skills/competences in talking, parenting, negotiating, etc
Teaching family members basic behavioral modification via relational functions
Unique strategies relevant to most concerning referral behaviors
Changes to those referral behaviors are evidence of success

32. Evidence of Progress in Behavior Change
Referral Behaviors of Youth and/or Parent
Need to have clear and specific understanding of what referral behaviors are being monitored by referral source
Need to consider additional behaviors of concern
Want a “baseline” for these behaviors as launch BC
Substance abuse: what, how much of each, how often
Truancy: how many days, tardy vs. missed days
Mental Health: what symptoms, how frequent, how severe
Changes to “baseline” of behaviors are indicators for progress in Behavior Change (started at 3 blunts daily; now 1 blunt 3x/week)

33. Evidence of Progress in Behavior Change
Changeable Risk Factors
Behavior Change and Generalization can overlap so that some activities of Generalization are launched while currently in Behavior Change
Examples of Changeable Risk Factors to possibly target during Behavior Change-Generalization
School
Work schedules
Negative influence of extended family
Negative influence of peers
Gang affiliation
Need measurable data to represent family’s success (e.g., new school enrollment, changed peer group)

34. Evidence of Progress in Behavior Change
Protective Factor Enhancement
In Behavior Change, you don’t want to “throw the baby out with the bath water” but instead be clear and specific about what abilities and strengths already exist at outset of Behavior Change so that you can measure changes to those protective factors if you are attempting to enhance them
For example, youth has strong bond with older cousin who has positive influence and so goal is to coach parents how to reach out to cousin when need support for youth

35. Evidence of Progress in Behavior Change
Family members practicing new skills, new strategies and new behavioral modification (via relational functions) during and between sessions
As Behavior Change sessions progress, therapists should find themselves shifting from constant coaching and modeling to less frequent prompts during session role plays
Outside of sessions, do all family members…
participate in homework?
provide examples of new ways they are using skills practiced with therapist?
Practice new strategies to increase desirable behaviors by proactively using relational functions as reinforcement?

36. Evidence of Progress in Behavior Change
Family adapting Behavior Change plan even further to help improve how they interact and meet functions
For example, Mom reports that she caught herself fussing at her son for being 5 minutes late (son to Mom connected) and so she came up with new strategy to interact with him when he comes home on time. She recognized she was reinforcing undesirable behaviors (coming home late) and shifted to reinforcing desirable behaviors (home on time) by using her knowledge that her son is motivated to achieve time interacting with her

37. Behavior Change Caveats
Matching to families is multi-faceted:
First and foremost matching is to Relational Functions
But what about developmental stages, cognitive abilities, etc…in essence, what is needed to make this work for the family members?
How much “cognitive” explaining of rationale may or may not be necessary
Do you teach them about their relational functions?
Do you tell them “why” we’re developing these skills?
How much “doing” in absence of explaining is best?
Who cares why, it just is better when we do it this way?

38. Adherence in Behavior Change
Does the therapist deliver the FFT Behavior Change Phase within the FFT timeframes?
Does “behavior change” begin as soon as possible, but only after the family experiences our motivation goals?
Does the therapist plan for the BC phase prior to first BC session?
Are the “behavior change targets” broken into small obtainable changes that are consistent with all family members’ relational functions and values (etc) ?
Are BC interventions clear and focused on specific skill development?
Copyright FFT LLC 2012